Illegal abortion: consequences for women's health and the health care system

Abortion, an increasing public health concern in Ecuador, a 10-year population-based analysis

OBJECTIVES

To describe the epidemiology of abortion in Ecuador from 2004 to 2014 and compare the prevalence between the public and the private health care systems.

METHODS

This is a cross-sectional analysis of the overall mortality and morbidity rate due to abortion in Ecuador, based on public health records and other government databases.

RESULTS

From 2004 to 2014, a total of 431,614 spontaneous abortions, miscarriage and other types of abortions were registered in Ecuador. The average annual rate of abortion was 115 per 1,000 live births. The maternal mortality rate was found to be 43 per 100,000 live births.

CONCLUSIONS

Abortion is a significant and wide-ranging problem in Ecuador. The study supports the perception that in spite of legal restrictions to abortion in Ecuador, women are still terminating pregnancies when they feel they need to do so. The public health system reported >84% of the national overall prevalence.

[Acute generalized peritonitis due to uterine perforation following abortion: case study observation]

L'avortement provoqué clandestinement est responsable d'une importante mortalité maternelle. Nous rapportons un cas de péritonite par perforation utérine post-abortive. Il s'agissait d'une patiente de 25 ans reçue pour des douleurs abdomino- pelviennes, vomissements et diarrhée, dans un contexte d'aménorrhée de 12 semaines. L'examen à l'admission retrouvait un tableau de péritonite asthénique. L'exploration chirurgicale notait une péritonite aigue généralisée secondaire à une perforation du dôme utérin, avec collection purulente de 1500 cc; anses grêles dilatées et multiples fausses membranes. Le geste chirurgical: aspiration du pus, toilette péritonéale; suture utérine, drainage.les suites opératoires étaient simples, le retour à domicile de la patiente a été autorisé à J 15.

The sociocultural context of family size preference, ideal sex composition, and induced abortion in India: findings from India's National Family Health surveys

In this study, the author examined the effect of family size preference and sex composition of living children as determinants of induced abortion among women in India by analyzing 90,303 ever-married women aged 15-49, included in India's second National Family Health Survey, conducted in 1998-99. Multivariate logistic regression methods were used to examine the association between induced abortion and possible determinants. The results indicated that a woman's desire to limit family size with preferred sex composition of children, coupled with her autonomy and the sociocultural context, largely determines her experience of induced abortion in India.

Abortion and human rights

Abortion has been a reality in women's lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women's lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus.

Abortion in democratic Spain: the parliamentary political agenda 1979-2004

Since Spain's transition to democracy, abortion has been a public policy issue both inside and outside parliament. This paper describes the history of abortion law reform in Spain from 1979 to 2004 and analyses the discourse on abortion of members of the Spanish parliament by sex and political allegiance. The analysis is based on a retrospective study of the frequency of legislative initiatives and the prevalence of different arguments and positions in debates on abortion found through a systematic search of the parliamentary database. Little time was given to abortion in the parliamentary agenda compared to other women's issues such as violence against women. There were 229 bills and other parliamentary initiatives in that period, 60% initiated and led by pro-choice women. 143 female and 72 male parliamentarians took part in the debates. The inclusion of socio-economic grounds for legal abortion (64%), and making abortion on request legal in the first 12 weeks of pregnancy (60%) were the most frequent forms of law reform proposed, based most often on pro-women's rights arguments. Male and female members of anti-choice parties and most male members of other parties argued for fetal rights. Pro-choice parties tabled more bills than anti-choice parties but till now all reforms proposed since 1985 have been voted down.

Maternal mortality in developing countries

Of all health statistics mentioned by the World Health Organization (WHO), maternal mortality is unique in showing the largest discrepancy between developed and developing countries. Approximately 90% of maternal deaths (more than 0.5 million each year) occur in developing countries. Over the last century, almost all countries have accepted antenatal care principles. However, insufficiency of resources and lack of women's compliance were the main handicaps in developing countries and compelled these countries to apply various standard programs. Unfortunately, these programs are not sufficiently effective in the prevention and treatment of maternal mortality. Fixing the number (quantity) of antenatal visits and the static approach affect the "quality" of antenatal care. Bleeding, chronic anemia, hypertensive disorders, obstructed labor, unsafe abortions and infections are the main factors leading to maternal mortality. The majority of these factors are preventable. It is important to suspect the presence of any of these factors and to intervene promptly both during antenatal care and immediately after delivery. The evidence-based approach is a way of reaching this solution. Antenatal care is a concept that extends from pre-pregnancy to postpartum, leading to effective emergency care for unpredictable and predictable complications during pregnancy and childbirth. Worldwide policies are not always applicable to each country, coercing national policies. There is still a need for prospective randomized trials to clarify this concept and the relevant policies.

Reproductive health and obstetricians and gynecologists

The art of medicine provides a rare opportunity to understand human values and to contribute toward the well-being of one's fellow humans--women in the case of ob-gyn--a contribution that fits in with the mission of the International Federation of Gynaecology Obstetrics (FIGO). Obstetricians and gynecologists should indeed take it upon themselves to improve conditions for women, since the bond and respect between the two is a significant one. It is obstetricians-gynecologists who can provide the much needed technical information to throw light on justifying services that deal with devastating, debilitating, degenerating, and devaluating situations, such as neglected pregnancy, disregard toward cancer detection, and humiliating genital mutilation. Indeed, this can be termed as "terrorism in ob-gyn," neglected by those who should deal with it. Those in ob-gyn and other medical professions clearly witness gender inequality and its ugly aftermath, a degradation of women's reproductive rights. Ob-gyn must look a little beyond just the lucrative practice of the plain science of obstetrics and gynecology and undertake the responsibility to help and protect the health and life of women around the world. A conscientious doctor cannot practice medicine on women's bodies alone, but must also "practice" against several social evils, the prevention of which is crucial to women's health. Obstetricians and gynecologists can utilize their access to policymakers and health "builders" to carry this brief for women's health, and can urge governments to take a second look at women's rights to ensure that they are on par with the accepted norms of human rights, to be protected and propagated.

[Male perspective on induced abortion]

OBJECTIVE

To analyze the perspective on induced abortion of men of a university community living in legal or consensual wedlock.

METHODS

A descriptive cross-sectional study was carried out and 361 members of different categories of an university were interviewed. Chi-square test was used to assess the association between dependent and independent variables.

RESULTS

Fifth-three percent of the participants acknowledged that women have the right to end pregnancy. Men were more favorable to abortion when there is a risk to woman's life (85%); rape-related pregnancy (80%); and fetal anomalies (75%). Higher schooling of both men and their partners and the interviewees' position (teacher/student) were associated to a positive attitude towards abortion.

CONCLUSIONS

Men tended to be more prone to abortion in legally and/or socially accepted instances. Better education of both men and their partners was relevant to determine their attitude towards abortion.

Unsafe abortion in adolescents

Every year, an estimated 2.0-4.4 million adolescents resort to abortion. In comparison with adults, adolescents are more likely to delay the abortion, resort to unskilled persons to perform it, use dangerous methods and present late when complications arise. Adolescents are also more likely to experience complications. Consequently, adolescents seeking abortion or presenting with complications of abortion should be considered as a medical emergency. Issues requiring special attention in the management of abortion complications in adolescents are identified. Approaches to adolescent abortion should involve all levels of the health care system, as well as the community, and should include not only management of the consequences of unsafe abortion, but also post-abortion contraception and counseling. Prevention of unwanted pregnancy by providing information on sexuality, ensuring that reproductive health services are adolescent-friendly, creating a supportive environment, building young people's social and decision-making skills, and offering counseling in times of crisis are highlighted.

An historical review of criminal abortion

Criminal abortion is rarely seen in modern Australia. This historical review examine cases seen in Brisbane during the period 1939 and 1947. Instrumentation or introduction of fluid into the uterus were the common causes of fatalities in this pre-penicillin era.

The role of FIGO in the advancement of women's health - in the year 2000

The paper reviews the role and activities of FIGO as a global federation with a mission to promote the health and well-being of women and to improve the practice of gynecology and obstetrics.

Abortion complications in Abidjan (Ivory Coast)

The aim of this study was to describe the various methods of abortion used by women admitted to an obstetrics department in Abidjan (Ivory Coast) for abortion complications. The study was retrospective, and was based on the medical files of all 472 women admitted for abortion complications during a 3-year period (1993-1995). The introduction of plant stems into the uterus, the use of certain instruments, use of vaginal preparations, and ingestion of plants were the most common abortion methods. Seventeen maternal deaths were registered, giving a maternal mortality rate of 3.6%. A high number of previous pregnancies and the ingestion of plants to provoke abortion were factors associated with the highest risk for maternal death. Complications of "local" abortion methods accounted for a high proportion of maternal deaths.

Abortion and maternal health

Since the beginning of recorded history, women have attempted to terminate unwanted pregnancies. Despite the safety of modern techniques of abortion, many women throughout the world still have to resort to unsafe abortions, placing themselves at considerable risk. The World Health Organization estimates that there are approximately 20 million unsafe abortions performed each year, and estimates of maternal deaths as a result of abortion range between 60,000 and 100,000 per year. With free and legal access to safe abortions, rates of complications and mortality drop dramatically. There is an urgent need for efforts to prevent unwanted pregnancies in order to reduce the need for abortion; for the early identification of abortion complications and easy access to treatment for women suffering those complications; for expansion of safe abortion availability; and for proper training and resources for providers of abortion services.

Medical versus surgical abortion

OBJECTIVE

To evaluate the safety, efficacy, and acceptability of an oral drug regimen of medical abortion compared with surgical abortion.

MATERIALS AND METHODS

500 women with amenorrhea < 56 days chose either surgical abortion or 600 mg of mifepristone (RU-486) followed by 400 microg of misoprostol after 48 h.

RESULTS

Medical regimen had more side effects than surgical abortion, including bleeding, cramping, nausea and vomiting. Only fever was more frequent in the surgical method. The failure rates for medical abortion exceeded those for surgical abortion, 16.0% vs. 4.0%. The adolescents' failure rate in the medical regimen group was only 1.7%. Several failures on medical abortion were not true drug failures, but surgical interventions not medically necessary (misdiagnosis). Women were satisfied with either method, but more preferred medical abortion.

CONCLUSION

Medical methods are safe, effective, simpler and potentially allow greater privacy than surgical abortion methods. Therefore, medical methods could be the method of choice for abortion, particularly for adolescents.